2017-03-07 17:41:09
G.O.P. Health Bill Faces Revolt From Conservative Forces

WASHINGTON — A long-awaited plan to repeal the Affordable Care Act and remake the American health care system faced a revolt from the right on Tuesday as conservative groups and lawmakers strongly criticized a bill that Republican leaders and President Trump had hoped to jam through Congress this month.

“This is not the Obamacare repeal bill we’ve been waiting for. It is a missed opportunity and a step in the wrong direction,” said Senator Mike Lee, Republican of Utah, who was joined by a constellation of conservative groups, including the Club for Growth, Heritage Action for America and Charles G. and David H. Koch’s Americans for Prosperity. “We promised the American people we would drain the swamp and end business as usual in Washington. This bill does not do that.”

The Republican bill, released Monday night after months of negotiation, would scrap the mandated coverage in President Barack Obama’s signature domestic achievement in favor of tax incentives to coax people to purchase health care. But the legislation maintains many of the Affordable Care Act’s mandates and basic benefits, including prohibiting insurers from denying policies for pre-existing conditions or capping benefits in a year or a lifetime.

That has led to charges among conservatives that the bill would be nearly as disruptive to the free market as the law it is replacing, and to concern among experts that it could send insurance premiums skyrocketing, with only small tax credits to defray the cost for consumers seeking policies.

Mr. Lee and Senator Rand Paul, Republican of Kentucky, along with several conservative House members, plan to hold a news conference Tuesday afternoon to denounce the bill — Mr. Trump’s posts on Twitter notwithstanding. “The House leadership Obamacare Lite plan has many problems,” Mr. Paul said Tuesday on Twitter. “We should be stopping mandates, taxes and entitlements not keeping them.”

While House members had yet to return from their districts Tuesday afternoon, the pressure from their years of promising to wipe out Mr. Obama’s signature legislation had arrived for payment. The conservative groups that have been the backbone of their financial and political support are already in revolt.

Republicans have been counting on a stately endorsement of their plan from Mr. Trump, who is widely viewed as the tugboat that will be needed to bring the large, last-minute bill over the line. While his Twitter posts on Tuesday were generally supportive of the House plan, he raised the idea that the bill was “out for review and negotiation,” hardly an unqualified endorsement. And the White House appears to have no plans for the kind of barnstorming efforts that past presidents have mounted to advance major pieces of legislation.

In essence, House Republicans may have backed themselves into a political corner. They accomplished too little in shrinking the size of the government’s role in the health sector to pull the most conservative members their way, yet they may not have done enough to allay the concerns of Republican senators who are skeptical of elements like rolling back the Medicaid expansion and the defunding of Planned Parenthood, at least in the short run.

For example, the tax credits offered in the plan do not appear to adjust for states with higher market costs, a red flag for senators from states like North Carolina, which may explain why one of that state’s Republican senators, Richard M. Burr, called the House plan on Tuesday “a good first step toward providing relief from the broken promises, costly mandates and government bureaucracy created by Obamacare.”

In an interview with a local radio station on Tuesday, Senator Roy Blunt, Republican of Missouri, said, “What I don’t like is it may not be a plan that gets a majority of votes and lets us move on, because I think we can’t stay where we are with the plan we’ve got now.”

What’s more, Republicans have opened themselves up to the same criticisms that they leveraged at Democrats in 2010 about the process and transparency of legislating. The bill is going to two House committees on Wednesday for simultaneous revisions a mere two days after being released — and before the Congressional Budget Office has determined how much the measure would cost and how many people would lose or gain insurance. If the bill is passed by the full House as early as next week, Senator Mitch McConnell has promised to bring it immediately to the Senate floor without a single hearing.

Noting that they expected no help from Democrats, Senator John Cornyn of Texas, the No. 2 Republican, said the decision had been made to cobble together the final draft among Republicans from both chambers. “There’s already been a lot of consulting on a bicameral basis,” he said. “We’re not going to do this with Democrats.”

“Republicans are irresponsibly rushing forward before this bill even receives a score from C.B.O.,” Senator Chuck Schumer of New York, the Democratic leader, said on the Senate floor on Tuesday. “After years of howling at the moon about Democrats rushing through the Affordable Care Act — the mantra they said over and over and over again on the floor here and in the House, ‘read the bill’ — Republicans are having committee votes two days after the bill is released. No wonder they don’t want anyone to know what’s in the bill.”

Even some Republicans were squeamish. “We need to see the score,” said Senator Bill Cassidy, Republican of Louisiana, who has a more moderate bill of his own to replace the law. “It would be difficult for me personally to make such a vote” without one, he added.

Senator Heidi Heitkamp of North Dakota, the sort of moderate Democrat that Republicans had hoped to help them tweak the law next year, said she understood that Republicans might believe they have been out front with their ideas for years. “But to not have metrics and evaluative tools” would make it hard to accept the current version, she said.

“The challenge I have is I agree that there are a number of things in the law that need to be fixed,” she said, but that Republicans are now “taking the whole structure and tearing it down.”